1912375163 NPI number — MR. AHMED MOHAMED MAHMOUD GHANEM PT

Table of content: MR. AHMED MOHAMED MAHMOUD GHANEM PT (NPI 1912375163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912375163 NPI number — MR. AHMED MOHAMED MAHMOUD GHANEM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHANEM
Provider First Name:
AHMED
Provider Middle Name:
MOHAMED MAHMOUD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912375163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/11/2016
NPI Reactivation Date:
04/20/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 FIFTH AVENUE
Provider Second Line Business Mailing Address:
SUITE 906
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-973-8299
Provider Business Mailing Address Fax Number:
212-937-3304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 906
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-973-8299
Provider Business Practice Location Address Fax Number:
212-937-3304
Provider Enumeration Date:
09/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  038313-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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